Provider Demographics
NPI:1427728054
Name:BUGG, LAWRENCE M (CPO)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:M
Last Name:BUGG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1107
Mailing Address - Country:US
Mailing Address - Phone:989-912-2100
Mailing Address - Fax:989-912-2102
Practice Address - Street 1:4511 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1107
Practice Address - Country:US
Practice Address - Phone:810-230-6688
Practice Address - Fax:810-230-6689
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02146224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist